MyMedR

Salivary gland anlage tumour of the nasopharynx: A case report and review for histopathological characteristics

Başak K, Günhan Ö, Akbulut S, Aydin S

Malays J Pathol, 2019 Dec;41(3):345-350.

PMID: 31901920

INTRODUCTION: Congenital salivary gland anlage tumour of the nasopharynx is a lesion which usually presents with nasal and upper respiratory tract obstruction in the neonatal period. Timely diagnosis is essential to prevent the occurrence of respiratory complications in later childhood.

CASE REPORT: We present a 8-year-old boy complaining from difficulty in breathing and breastfeeding in the neonatal period due to an adenoid-like nasopharyngeal mass. Histological examination revealed solid and cystic squamous nests and numerous duct-like structures within collagenised stroma. Both epithelial and myoepithelial differentiation were noted in the tubular component.

DISCUSSION: A review of the clinical and histopathological features of published cases revealed that ancient lesions showed more prominent and complex epithelial component and more collagen rich stroma. We would like to suggest the possibility of salivary gland anlage tumour to be considered in the differential diagnosis of neonatal respiratory distress cases.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

Fulltext A novel and non-invasive approach utilising nasal washings for the detection of nasopharyngeal carcinoma

Tan GW, Sivanesan VM, Abdul Rahman FI, Hassan F, Hasbullah HH, Ng CC, et al.

Int J Cancer, 2019 Oct 15;145(8):2260-2266.

PMID: 30698824 DOI: 10.1002/ijc.32173

Nasopharyngeal carcinoma (NPC) is an epithelial cancer of the nasopharynx which is highly associated with Epstein-Barr virus (EBV). Worldwide, most of the top 20 countries with the highest incidence and mortality rates of NPC are low- and middle-income countries. Many studies had demonstrated that EBV could be detected in the tissue, serum and plasma of NPC patients. In this study, we explored the potential of assays based on non-invasive nasal washings (NW) as a diagnostic and prognostic tool for NPC. A total of 128 patients were evaluated for NW EBV DNA loads and a subset of these samples were also tested for 27 EBV and human miRNAs shortlisted from literature. EBV DNA and seven miRNAs showed area under the receiver operating characteristic curve (AUC) values of more than 0.7, suggestive of their potential utility to detect NPC. Logistic regression analyses suggested that combination of two NW assays that test for EBNA-1 and hsa-miR-21 had the best performance in detecting NPC. The trend of NW EBV DNA load matched with clinical outcome of 71.4% (10 out of 14) NPC patients being followed-up. In summary, the non-invasive NW testing panel may be particularly useful for NPC screening in remote areas where healthcare facilities and otolaryngologists are lacking, and may encourage frequent testing of individuals in the high risk groups who are reluctant to have their blood tested. However, further validation in an independent cohort is required to strengthen the utility of this testing panel as a non-invasive detection tool for NPC.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Fulltext Exome Sequencing Identifies Potentially Druggable Mutations in Nasopharyngeal Carcinoma

Chow YP, Tan LP, Chai SJ, Abdul Aziz N, Choo SW, Lim PV, et al.

Sci Rep, 2017 03 03;7:42980.

PMID: 28256603 DOI: 10.1038/srep42980

In this study, we first performed whole exome sequencing of DNA from 10 untreated and clinically annotated fresh frozen nasopharyngeal carcinoma (NPC) biopsies and matched bloods to identify somatically mutated genes that may be amenable to targeted therapeutic strategies. We identified a total of 323 mutations which were either non-synonymous (n = 238) or synonymous (n = 85). Furthermore, our analysis revealed genes in key cancer pathways (DNA repair, cell cycle regulation, apoptosis, immune response, lipid signaling) were mutated, of which those in the lipid-signaling pathway were the most enriched. We next extended our analysis on a prioritized sub-set of 37 mutated genes plus top 5 mutated cancer genes listed in COSMIC using a custom designed HaloPlex target enrichment panel with an additional 88 NPC samples. Our analysis identified 160 additional non-synonymous mutations in 37/42 genes in 66/88 samples. Of these, 99/160 mutations within potentially druggable pathways were further selected for validation. Sanger sequencing revealed that 77/99 variants were true positives, giving an accuracy of 78%. Taken together, our study indicated that ~72% (n = 71/98) of NPC samples harbored mutations in one of the four cancer pathways (EGFR-PI3K-Akt-mTOR, NOTCH, NF-κB, DNA repair) which may be potentially useful as predictive biomarkers of response to matched targeted therapies.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Inclusion bodies of recombinant Epstein-Barr virus capsid antigen p18 as potential immobilized antigens in enzyme immunoassays for detection of nasopharyngeal carcinoma

Lim CS, Goh SL, Kariapper L, Krishnan G, Lim YY, Ng CC

Clin Chim Acta, 2015 Aug 25;448:206-10.

PMID: 26164385 DOI: 10.1016/j.cca.2015.07.008

Development of indirect enzyme-linked immunosorbent assays (ELISAs) often utilizes synthetic peptides or recombinant proteins from Escherichia coli as immobilized antigens. Because inclusion bodies (IBs) formed during recombinant protein expression in E. coli are commonly thought as misfolded aggregates, only refolded proteins from IBs are used to develop new or in-house diagnostic assays. However, the promising utilities of IBs as nanomaterials and immobilized enzymes as shown in recent studies have led us to explore the potential use of IBs of recombinant Epstein-Barr virus viral capsid antigen p18 (VCA p18) as immobilized antigens in ELISAs for serologic detection of nasopharyngeal carcinoma (NPC).

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Waldeyer ring lymphoma: a case series

Teh CS, Jayalakshmi P, Chong SY

Ear Nose Throat J, 2014 Sep;93(9):E22-5.

PMID: 25255354

We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients-14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n = 17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

On optimizing the blocking step of indirect enzyme-linked immunosorbent assay for Epstein-Barr virus serology

Lim CS, Krishnan G, Sam CK, Ng CC

Clin Chim Acta, 2013 Jan 16;415:158-61.

PMID: 23043757 DOI: 10.1016/j.cca.2012.08.031

Because blocking agent occupies most binding surface of a solid phase, its ability to prevent nonspecific binding determines the signal-to-noise ratio (SNR) and reliability of an enzyme-linked immunosorbent assay (ELISA).

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Fulltext A rare case of nasopharyngeal carcinosarcoma

Lim AL, Zahirrudin Z, Pua KC

Med J Malaysia, 2012 Aug;67(4):428-9.

PMID: 23082458 MyJurnal

Nasopharnygeal carcinoma is known to be the commonest tumour of the nasopharynx. However, the incidence of nasopharngeal carcinosarcoma is extremely rare. Carcinosarcoma has been reported to be aggressive in nature and therefore early diagnosis and prompt treatment is important. We report a young lady who was diagnosed with nasopharyngeal carcinosarcoma in our centre. She presented with only 2 weeks history of nose block and was noted to have a mass occupying the nasopharynx with neck metastasis. She underwent panendoscope and biopsy with radical radiotherapy.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

Exploring the knowledge of nasopharyngeal carcinoma among medical doctors at primary health care level in Perak state, Malaysia

Balachandran R, Philip R, Avatar S, Simon R, Mann GS, Benedict CT, et al.

Eur Arch Otorhinolaryngol, 2012 Feb;269(2):649-58.

PMID: 21691719 DOI: 10.1007/s00405-011-1665-0

Nasopharyngeal carcinoma (NPC) is among the commonest cancers in Malaysia. The prognosis for NPC like most other head and neck cancer is dependent on its staging. Majority of patients in Malaysia at the time of diagnosis are either at stage III or IV (27 and 47%, respectively). The lack of knowledge among primary care medical doctors regarding NPC may contribute to this delay in diagnosis. The aim of this study was to assess the knowledge of the primary care doctors in the state of Perak on the various aspects of NPC. The doctors at the primary care level in the state of Perak were recruited to take part in this study on a voluntary basis. A total number of 154 out of 198 doctors participated in this survey. They were given a questionnaire to fill in to test their knowledge on different aspects of NPC and its treatment. The overall respondents' score was poor with a score of 67.5% on all sections. The doctors appear to be able to identify common presenting features of NPC with a mean score of 85.3% but for the uncommon presentations of NPC, the scores were poorer with 61.8%. In addition, 54.1% of the participants answered that they would refer a patient with symptoms suspicious of NPC after a period of 1 month from the onset of symptom. However, only 34% would refer within 2 weeks. Based on the results of this study, the authors feel that it is clear that the doctors posted in the primary care hospitals and clinics appear to have inadequate knowledge to diagnose and refer patients with suspected NPC. As early diagnosis can often lead to a better prognostic outcome, steps must be taken to raise the awareness among these doctors.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Novel Epstein-Barr virus immunoglobulin G-based approach for the specific detection of nasopharyngeal carcinoma

Abdulamir AS, Hafidh RR, Abu Bakar F, Abbas K

Am J Otolaryngol, 2010 Nov-Dec;31(6):410-7.

PMID: 20015794 DOI: 10.1016/j.amjoto.2009.06.006

PURPOSE: This study was designed to find a reliable Epstein-Barr virus (EBV) immunoglobulin (Ig) G-based diagnostic/screening test for nasopharyngeal carcinoma (NPC) able to demarcate between the NPC-related seropositivity of EBV IgG antibodies and that of other head and neck cancer (HNCA) and control groups. The NPC-associated immunosuppression affects EBV IgA much more than IgG, leading to inconsistent detection of NPC using EBV IgA antibodies.
MATERIALS AND METHODS: One hundred twenty-two HNCA patients, 42 NPC, 66 laryngeal carcinoma, and 14 hypopharyngeal carcinoma and 3 groups of 100 control subjects were enrolled in this study. Enzyme-linked immunosorbent assay (ELISA) was used to find a specific cutoff value for the NPC-related seropositivity of EBV IgG antibodies.
RESULTS: NPC group showed higher serum level of EBV IgG antibodies than control and other HNCA groups (P < .05). However, the traditional cutoff value, mean + 2 SDs of control subjects, failed to demarcate the seropositives of NPC patients from those of healthy population (P > .05). The new cutoff value, mean + 2 SDs of the seropositives group of control subjects who had already been grouped by the traditional cutoff value, proved successful. It succeeded to demarcate between the NPC-related EBV IgG seropositivity and that issued from the persistent, latent, or reactivated EBV infection in the population (P < .05). The sensitivity/specificity of NPC detection by the new cutoff-based ELISA kit, 76.19% and 86%, was close or higher than that of EBV IgA antibodies.
CONCLUSION: EBV IgG-based ELISA could be used for the diagnosis of NPC using a new cutoff threshold that excludes the population baseline of EBV IgG seropositivity.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

Fulltext Juvenile nasopharyngeal angiofibroma in a tertiary centre: ten-year experience

Tang IP, Shashinder S, Gopala Krishnan G, Narayanan P

Singapore Med J, 2009 Mar;50(3):261-4.

PMID: 19352568

This is a retrospective study that aimed to examine the outcomes of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) at a tertiary centre in Malaysia.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Fulltext Nasopharyngeal Carcinoma Database

Pua KC, Khoo AS, Yap YY, Subramaniam SK, Ong CA, Gopala Krishnan G, et al.

Med J Malaysia, 2008 Sep;63 Suppl C:59-62.

PMID: 19230249

Nasopharyngeal carcinoma (NPC) is a cancer which is common in Asia. We report the establishment and early results of a multi-institutional prospective study of nasopharyngeal carcinoma, which seeks to systematically collect data as well as blood and tumour tissue samples from patients diagnosed with nasopharyngeal cancer at six centres in Malaysia. A total of 484 confirmed NPC cases were reported from the six participating centres between 1st July 2007 and 29th February 2008. Of these, 225 were newly diagnosed cases, 53 were recurrent cases and 206 were in remission at the time of reporting. Amongst the newly diagnosed cases, the most common presenting symptom was the presence of neck lumps (42%). Ophthalmo-neurologic symptoms were the presenting symptoms of 11% of the new cases. The majority of cases (75%) presented at stage III/IV.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

Fulltext Nasopharyngeal carcinoma: recognizing it early in children with otitis media with effusion

Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2008 Aug;63(3):261-2.

PMID: 19248706 MyJurnal

Nasopharyngeal carcinoma (NPC) is a rare disease in children. Children with NPC almost always have the undifferentiated variant of the disease, which is associated with advanced locoregional and distant metastasis. We report two cases to illustrate that high index of suspicion is necessary to diagnose NPC in children especially those with atypical presentation of otitis media with effusion (OME).

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia

Devi BC, Tang TS, Corbex M

Ann. Oncol., 2007 Jul;18(7):1172-6.

PMID: 17434897 DOI: 10.1093/annonc/mdm105

BACKGROUND:
The registry of the Oncology Departmental in Sarawak General Hospital showed that 79% of nasopharyngeal, 77% of breast and 70% of cervix cancer patients were diagnosed at an advanced stage (stages III and IV) for year 1993. Hence, a low cost Early Cancer Surveillance Program was started in 1994, with the intent of downstaging these three most common cancers in Sarawak.

MATERIALS AND METHODS:
The program consisted of (i) training health staff in hospital and rural clinics to improve their skills in early cancer detection, (ii) raising public awareness through pamphlets, posters and sensitization by health staff.

RESULTS:
Data analysis revealed that the program achieved downstaging in two of the cancers. Breast cancer in stage III and IV was reduced from 60% (1994) to 35% (1998) (P < 0.0001) and cervical cancer in stage III and IV from 60% (1994) to 26% (1998) (P < 0.0001). No reduction was observed for nasopharyngeal cancer at 88% (1994) to 91% (1998).

CONCLUSIONS:
The overall cost of this program was

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

Epstein-Barr virus DNA detection in the diagnosis of nasopharyngeal carcinoma

Yap YY, Hassan S, Chan M, Choo PK, Ravichandran M

Otolaryngol Head Neck Surg, 2007 Jun;136(6):986-91.

PMID: 17547993

OBJECTIVES: This study examines the presence of Epstein-Barr virus (EBV) in nasopharyngeal carcinoma (NPC) by using polymerase chain reaction (PCR).

STUDY DESIGN: Eighty-six postnasal biopsy samples and 71 fine-needle aspirate samples of neck masses were obtained from patients who were clinically suspect for NPC. Genomic DNA was extracted from the samples, and EBNA1, EBNA2, and LMP genes of EBV were detected by PCR. PCR results were compared with NPC histopathology findings.

RESULTS: The sensitivity of PCR to detect EBNA1 (97.14%), EBNA2 (88.57%), and LMP (91.43%) genes of EBV in nasopharyngeal biopsy samples were higher than those in fine-needle aspirate samples.

CONCLUSION: Detection of EBV by PCR in tissue obtained from nasopharyngeal biopsy and fine-needle aspirate samples of neck masses is a relatively inexpensive, reliable, and accurate method of diagnosing NPC. Detection of EBV genes is on par with histopathological examination (HPE) and superior to fine-needle aspirate cytology.

SIGNIFICANCE: PCR is an ideal tool for suggesting NPC and guiding the diagnostic workup in occult primary tumors, facilitating earlier diagnosis and reducing morbidity and mortality.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Fulltext Evaluation of plasma Epstein-Barr virus DNA load as a prognostic marker for nasopharyngeal carcinoma

Tan EL, Looi LM, Sam CK

Singapore Med J, 2006 Sep;47(9):803-7.

PMID: 16924363

Nasopharyngeal carcinoma (NPC) is an important cancer in Malaysia and is one of the major causes of cancer mortality in this country. This study evaluates the diagnostic and prognostic values in the quantitative relationship between the cell-free Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) load and the tumour burden.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Quantification of Epstein-Barr virus DNA load, interleukin-6, interleukin-10, transforming growth factor-beta1 and stem cell factor in plasma of patients with nasopharyngeal carcinoma

Tan EL, Selvaratnam G, Kananathan R, Sam CK

BMC Cancer, 2006;6:227.

PMID: 16995954

Nasopharyngeal carcinoma (NPC) is a common epithelial neoplasm among the Chinese populations in Southern China and South East Asia. Epstein-Barr virus (EBV) is known to be an important etiologic agent of NPC and the viral gene products are frequently detected in NPC tissues along with elevated antibody titres to the viral proteins (VCA and EA) in a majority of patients. Elevated plasma EBV DNA load is regarded as an important marker for the presence of the disease and for the monitoring of disease progression. However, other serum/plasma parameters such as the levels of certain interleukins and growth factors have also been implicated in NPC. The objectives of the present study are, 1) to investigate the correlations between plasma EBV DNA load and the levels of interleukin (IL)-6, IL-10, TGF-beta1 and SCF (steel factor) and 2) to relate these parameters to the stages of NPC and the effect of treatment.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Fulltext Sino-nasal hemangiopericytoma--a rare tumor

Vikneswaran T, Gendeh BS, Tan VES, Phang KS, Saravanan K

Med J Malaysia, 2005 Oct;60(4):485-8.

PMID: 16570712

Hemangiopericytoma is a very rare angiogenic tumor. In the nasal cavity, it can be considered malignant. It occurs in various parts of the body but those in the nasal cavity account for only 5% of total cases. Less than 200 cases have been reported worldwide involving the nose and paranasal sinuses. Due to its rarity a proper line of management has not been established to tackle this tumour. This article highlights two cases of hemangiopericytoma (HPC), one in an adult and the other in a child, presenting as an intranasal mass.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Epstein-Barr virus serology in the diagnosis of nasopharyngeal carcinoma

Wong MM, Lye MS, Cheng HM, Sam CK

Asian Pac J Allergy Immunol, 2005 Mar;23(1):65-7.

PMID: 15997877

The antibody levels to viral capsid antigen (VCA) and early antigen (EA) of Epstein-Barr virus (EBV) in 164 nasopharyngeal carcinoma (NPC) patients from Sarawak, East Malaysia were significantly higher than those in 147 sex, age and ethnically matched healthy controls. As diagnostic markers of NPC, IgG/VCA at reciprocal titers > or =160 was the most sensitive (89%, with 98% specificity), while IgA/EA at > or =5 was the most specific (100%) but the least sensitive (75%). The sensitivity and specificity of IgA/VCA at reciprocal titers > or =10 were 84% and 97%. IgA/VCA has an advantage over IgG/VCA despite the slightly lower sensitivity due to its consistently more distinct fluorescence reaction. The sensitivity and specificity can be marginally improved by a combination of two tests.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis*

Fulltext Clinical presentation of patients with nasopharyngeal carcinoma

Suzina SAH, Hamzah M

Med J Malaysia, 2003 Oct;58(4):539-45.

PMID: 15190630

The poor prognosis for patients with nasopharyngeal carcinoma is principally due to its advanced stage at the time of diagnosis. The symptoms and clinical findings at presentation of 56 patients with confirmed nasopharyngeal carcinoma is described and analysed. Recognising the common modes of presentation is essential to diagnose the disease at an early stage.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

Hypertrophic osteoarthropathy: an unusual manifestation in nasopharyngeal cancer

Biswal BM, Kareem A, Ahmed NM

Australas Radiol, 2001 Feb;45(1):71-3.

PMID: 11259979 DOI: 10.1046/j.1440-1673.2001.00883.x

A patient with nasopharyngeal carcinoma developed clubbing and hypertrophic osteoarthropathy 6 months before radiological detection of secondary deposits in the lung. Another patient with nasopharyngeal carcinoma developed digital clubbing and hypertrophic osteoarthropathy 6 months after the discovery of lung metastases. Development of a paraneoplastic syndrome in the form of hypertrophic osteoarthropathy and digital clubbing is very rare. This manifestation of nasopharyngeal cancers is presented, with a short review of its biology and pathogenesis.

Matched MeSH terms: Nasopharyngeal Neoplasms/diagnosis

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